Indigent Attorney Application

If you are required to fill out an application, do not sign it before you bring it to the Municipal Court. A clerk must witness the signature and swear the defendant in. Please bring proof of income with the application.

This statement is made under oath. I hereby state that the above information regarding my financial condition is correct to the best of my knowledge. I hereby authorize the screening agent and the court to obtain information from financial institutions, employers, relatives, the federal internal revenue service and other state agencies.

State of New Mexico ) County of _________________ ) ss City of ___________________ ) Signed and sworn to (or affirmed) before me on ________________________ (date) by ________________________________________________________ (name of applicant).

______________________________ Notary

(Seal, if any) My commission expires: _______________________

I UNDERSTAND THAT IF IT IS DETERMINED THAT I AM NOT INDIGENT, I MAY APPEAL TO THE COURT WITHIN TEN (10) DAYS AFTER THE DATE I AM ADVISED OF THIS DECISION. ____ I wish to appeal. ____ I do not wish to appeal.

*(Dependent means any person who qualifies as a dependent of the applicant under Section 152 of the Internal Revenue Code.) Based on the above answers and information, I find that the applicant (is) (is not) indigent. (Complete the following only if the court has determined that the applicant is unable to pay the $10.00 application fee). ____ I find that the applicant is unable to pay the $10.00 indigency application fee, and I therefore waive the payment of the $10.00 application fee.